Kai Pedersen, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D012042 Issued in AZ

Practice address

2240 Winrow Rd
Fort Huachuca, AZ 85613-5080

Phone

(520) 533-9200

Fax

(520) 533-5246

NPI assigned

Jun 30, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1003486093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 WINROW RD",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "856135080",
            "telephone_number": "520-533-9200",
            "fax_number": "520-533-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 WINROW RD",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "856135080",
            "telephone_number": "520-533-9200",
            "fax_number": "520-533-5246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "KAI",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-30",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D012042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "D012042",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kai.c.pedersen.mil@mail.mil",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "9900 Lincoln Street 2nd Floor",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984310001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael Patrick Nolan, PHARM.D
• Tyler H Norton, PT, DPT
• Olymphia O'Neale-White, LCSW
• Jason Patrick, FNP-C
• Stefanie M Patrick, FNP-C
• Ritzie Miguel Perez
• Virginia Mary Perry, LPN
• Gail Pielack, FNP-C
• Kari Francine Pink, AUD
• David Lytle Pyle, PH.D.

• Dentist in Fort Huachuca, AZ
• Providers in Fort Huachuca, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.